According to the Centers for Disease Control and Prevention, the drug overdose death rate in the United States has more than tripled since 1990. And most of that comes from prescription painkillers. In 2008, 14,800 Americans died from a prescription painkiller overdose.

And data now show that prescription drugs are a major gateway to heroin addiction: About 80 percent of heroin users reportedly start off abusing painkillers. According to the National Institute on Drug Abuse, “Prescription opioid pain medications such as OxyContin and Vicodin can have effects similar to heroin when taken in doses or in ways other than prescribed, and they are currently among the most commonly abused drugs in the United States.”

U.S. Attorney General Eric Holder recently called the epidemic an “urgent and growing public health crisis” and encouraged first responders to carry naloxone, a drug that reverses the effects of overdoses. In Vermont, a state where treatment for opiate addiction has increased more than 770 percent since 2000, Gov. Peter Shumlin dedicated most of his State of the State address to the issue. “In every corner of our state, heroin and opiate drug addiction threatens us,” he said, outlining plans for better awareness and treatment, especially among incarcerated addicts.

1. Women

While men still are more likely to die from prescription drug overdoses than women, that gap is closing rapidly. The CDC says that since 1999, prescription painkiller overdose deaths increased more than 400 percent among women, compared with 265 percent among men, and about 18 women die from such an overdose every day in the U.S.

2. Teens and young adults

In 2012, The Center for Investigative Reporting’s California Watch project reported that prescription painkiller addiction was hitting affluent suburban neighborhoods in Southern California. Between the late 1990s to mid-2000s, states like Massachusetts and Ohio saw their painkiller epidemic turn into a heroin addiction problem, and the market for cheaper opiates made its way to California.

“Our kids are dying,” Dr. Robert Winokur of Mission Hospital in Mission Viejo says in the accompanying video. “These are good kids, these are athletes, these are cheerleaders, these are A students. It’s a terrible, terrible tragedy to see a 20-something-year-old die from a preventable illness.”

The video includes intimate portraits and stories of young people in Orange County, California, who start abusing prescription drugs before turning to heroin for a cheaper high, sometimes with fatal consequences.

3. Health care providers

A national review by USA Today shows “more than 100,000 doctors, nurses, medical technicians and health care aides are abusing or dependent on prescription drugs in a given year, putting patients at risk.” The number, which could be much higher, is a result of poor regulation and monitoring of medical care providers, who often can hide drug use.

4. Veterans

The number of opiate prescriptions given to those returning home from war has skyrocketed since 9/11. In September, a CIR investigation found that the U.S. Department of Veterans Affairs’ prescriptions of four potent opiates – hydrocodone, oxycodone, methadone and morphine – surged by 270 percent between 2001 and 2012, contributing to many deaths. As a result, the VA has testified before Congress about efforts to curb abuse and find alternative therapies.

5. The middle and upper-middle class

Treatment has become a big business with opiate addiction on the rise. Private equity firm Bain Capital saw opportunity in methadone clinics when it paid $58 million for a chain of treatment facilities in Massachusetts. Deni Carise, who works for Bain-owned CRC Health, a major substance abuse treatment provider, told The Boston Globe that opiates are affecting “a more middle- and upper-middle-class demographic. Addiction has always been an equal opportunity illness.’’